Objectives: To assess the evidence for tai chi in reducing resting blood pressure (BP) in the elderly. Methods: Databases were searched up to February 2009. All randomized clinical trials (RCTs) testing the effects of tai chi on resting BP in the elderly were considered. The selection of studies, data extraction and validation were performed independently by two reviewers. Methodological quality was evaluated using the Jadad score. Results: A total of 329 potentially relevant articles were identified and four RCTs met the inclusion criteria. One study suggested a significant BP reduction compared with no treatment or wellness education programme, while the others showed no effects compared with resistance exercise and usual activity. Two RCTs failed to show a reduction of resting BP compared with aerobic exercise, low impact exercise and no exercise control. Conclusion: The evidence for tai chi in reducing BP in the elderly individuals is limited. Whether tai chi has benefits over exercise is still unclear. The number of trials and the total sample size are too small to draw any firm conclusions. Further rigorous RCTs are warranted.